Herpes worry

[rochon]

I'm a 52 y/o male.  I had intercourse with a condom with a prostitute 6 days ago.  Three later I noticed one very small sore at border of my penis shaft and scrotum.  The day after I noticed this sore I developed a cough and the day after that a sore throat.  I don't have fever or any other flu-like symptoms.  I went to an STD doc to get it checked out immediately.  He did RPR, HSV-2 immunoassay antibody to gG-2, gonorrhea, syphillis, and chlamydia testing.  The RPR and HSV-2 testing came back negative.  He told me he thought the other testing would come back negative also.  Initially, he only saw one small sore which was not painful when he tested it for pain.  Because I'm married I pressed him for what my chances of having HSV-2 are.  After asking him, he took a look at the sore with a magnifying camera.  He said he saw a very small sore next to the noticeable one.  He said there was a 65% chance it was herpes.  He gave me Acyclovir to take to repress any potential herpes and suggested that I could safely have sex with my wife.  He also gave me Ciprofloxacin in case it was a bacterial infection (?).  I've read previous posts about herpes and was under the impression that, given the place of the sore and condom use, that my risk for herpes was pretty low but the doctor seemed to think otherwise.  The sore is flat.  I never noticed any blister.  I know it's difficult to second guess another doctor who has actually seen me but I want to get as much perspective as possible.  If it is HSV-2 how can I tell my wife?  Could I say I've must have had it for years and not known it?  We've been married 20 years.  Thanks

[rochon]

Thank you very much Dr Hood

[Edward W Hook, MD]

The acyclovir could just confuse things.  As I said before, I would not have prescribed it and would suggest stopping.  Then you can see what happens.  EWH

[rochon]

So you think he is wrong that taking the acyclovir will prevent the spread and allow me to find out if I have HSV-2 in Feb?  I'm afraid that my behavior will be the end of my marriage...

[Edward W Hook, MD]

The doctor you saw and I have different approaches.  

I don't know how the approach he suggested would help you to find out if the lesions was herpes or not.  

If the condom does not cover the lesion and if the lesion is herpes, you could pass it to your wife.  EWH

[rochon]

Since my potential HSV lesion is near the condom line does this mean that using a condom during sex won't protect my partner since there is a chance that the affected area will make contact with her?

[rochon]

Oops....the second line should have said "since I am married"

[rochon]

Thanks Dr Hook.  My MD said that if I was single he wouldn't have me on the ancyclovir but since I am this is a way to prevent me from giving it to my wife.  The lesion is so small that it is difficult to tell if it is already healing but I suspect it might be.  My MD said to come back in Feb, after taking the anclovir, and that if I test negative then I'm ok.  The lesion is near the condom line.  Also, when the MD listened to my lungs he thought I might have bronchitis.  Does this mean that I may have an upper respiratory infection in addition to whatever else is going on?  This was an expensive same-day clinic.  I wonder if I should have seen someone else....is it too late to try and see someone else on Monday?

[Edward W Hook, MD]

Welcome to our Forum.  I will try to help.  Condoms do dramatically reduce the risk for herpes infection and it is tough to tell if the lesion you describe is herpes or something else an there are many non-STD problems that could also cause the sort of lesion you describe. The IgG blood test your doctor took would have helped if this was a recurrence of a past infection but will not be helpful as this test can take up to 6 months to become positive following recent acquisition of infection.  As I understand it the sore you had is at the area near where the condom may have ended, is this correct?  If so, it is possible that the lesion you noted was HSV - the timing is correct and herpes lesions do not need to hurt.  Your doctor did not do you any favors if he started you on acyclovir without first taking a specimen for PCR or culture for the herpes virus.  It might still be worthwhile to take the PCR or culture test but the antiviral drugs could make these tests negative even if it was herpes.  

At this time you will have trouble finding out quickly whether this was HSV or not if the PCR or culture test is negative.   At this time, the important thing is to try to find out what there sore is caused by.  I would stop taking the acyclovir and ask your doctor to test the lesion.   In addition, if the lesion has resolved, should it recur, I would recommend testing for herpes with PCR or culture as described above.  EWH